One of the hardest parts of wheelchair prescription is working out what a person needs in the wheelchair for the years to come. For most people, we need the wheelchair to last approximately five years before they have funding available for a new one, although for children their wheelchairs are often replaced much sooner as they grow so quickly. Even when a person’s condition is static or unlikely to change significantly in the next few years, it can still be daunting trying to make sure all their needs are met in the one piece of equipment. This is even more daunting if the person has a progressive or degenerative condition and their function is expected to significantly change.
Degenerative conditions such as multiple sclerosis, muscular dystrophy, Parkinson’s disease or motor neuron disease can make wheelchair prescription more complex, but it doesn’t have to be intimidating. There are some important things to consider when prescribing, and they are often not as complex as initially feared.
One of the first things to do when scripting wheelchairs for people with progressive conditions is researching the person’s condition, especially if you do not know a lot about it. There are often common paths of progression that can be expected, but it’s still really important to remember that people aren’t usually textbook cases and their individual circumstances and progression will be different from another person’s. However, having some knowledge of what is typical progression is important to help predict what the person is likely to need. It is also important to have a good general knowledge of the condition, as there can be different classifications within conditions that have varying patterns of progression. For example, ‘relapse-remitting’ and ‘primary progressive’ are both types of multiple sclerosis but the patterns of progression vary significantly between them and this could impact on what is required. Your client is also a wealth of information on their condition – chances are that they know a lot about their condition and can also describe what it has meant for them personally and what they predict for the future.
The main concept to focus on when prescribing equipment is flexibility for the equipment to change with the person over time as needed. Below are some examples of what we need to consider when scripting wheelchairs for people with progressive conditions:
- What type of seating supports are needed now, and what could be needed in the future? A person might be able to sit in a neutral upright position independently at the time of the wheelchair scripting and delivery, but do you expect this to change? Should a backrest that allows for lateral supports to be fitted be prescribed to ensure that the backrest can be modified to suit the person as needed?
- Can any seating system be easily placed on the wheelchair in the future? Sometimes as much as we assess carefully for a certain seating system, or the cushion and backrest, it might no longer be suitable in the future and needs to be changed to something different. It is important to make sure that the wheelchair is scripted with the ability to change seating systems easily.
- What does the person’s pressure injury risk profile look like? At the time of assessment, they might be able to independently weight shift with no history of pressure areas so they would be classified as low risk, but are they continued to be projected at low risk? If a person’s ability to weight shift becomes limited or their continence is affected, their risk of developing pressure injuries will increase so it is important to consider projected pressure injury risk when scripting a wheelchair cushion.
- How will the person transfer in and out of the wheelchair in the future? They might be able to perform a standing transfer at the time of wheelchair delivery and so how the footplates are moved out of the way is important, but might be anticipated that a hoist transfer could be used in the future. Scripting the wheelchair so hoist transfers are also possible is important.
- For a manual wheelchair, how will the user propel the wheelchair? If they are able to self-propel independently at time of scripting, how can we maximise that ability for as long as possible while still making sure the wheelchair will be suitable if the person can no longer self-propel? How can we set up the wheelchair so that it is also easy for carers to push when needed, or for a power assist device to be fitted?
- For a person currently in a manual wheelchair or considering a manual wheelchair, would a power wheelchair actually be more appropriate in the medium to long term? If a person’s ability to self-propel reduces, or having a carer push the wheelchair full time is expected to be difficult, should a power wheelchair be considered early to ensure we maximise independence from the get-go?
- When prescribing power wheelchairs, what electronics system is on the wheelchair? The electronics system includes the joystick and the control modules, and can be either expandable or non-expandable. Non-expandable electronics have simpler types of controllers, with a single drive profile with speed dial. They usually have a drive program only, and one or two actuator controls which can be used for power seating functions, but the amount of power seating functions are limited. Non-expandable controllers do not have the capability of using alternate controls like head arrays or chin controls. In contrast, expandable electronics have multiple drive profiles available, have the ability to have numerous actuator controls so multiple power seat functions like tilt, recline, elevation and leg elevation can be used, and are also compatible with the use of alternate controls. For a person with a degenerative condition, a power wheelchair with expandable electronics is vital to ensure that the wheelchair programming can be fine tuned as their needs change, any power seat functions required can be prescribed, and the use of alternate controls are possible in the future if needed.
- For all types of wheelchairs, how easily can components be changed? If an armrest type or footplate design is no longer working, can it be changed for something that can better suit the person’s needs as they change?
- What is the funding situation like? Will it be easy to obtain funding quickly for changes needed to the wheelchair or seating in the future, or would it be beneficial to include things like lateral supports now if you think they will be needed in the short term?
Although we’ve mostly been focusing on wheelchair and seating prescription in this blog post, many of the considerations and principles discussed also apply to other types of assistive equipment. Our GTK consultants are experts in prescribing assistive technology equipment for clients with many different types of conditions, including progressive conditions. Contact us today to see how we can help.